干扰素释放试验(γ-干扰素)、腺苷脱氨酶、结核分枝杆菌脱氧核苷酸在结核性胸膜炎诊断中的对比

目的 探讨干扰素释放试验(γ-干扰素)、腺苷脱氨酶(ADA)、结核分枝杆菌脱氧核苷酸(TB-DNA)在结核性胸膜炎诊断中的效果.方法 128例患者分为结核性胸腔积液(结核组)与非结核胸腔积液组(非结核组),并通过对2组患者的ADA、TB-DNA及IFN-γ三种因子进行检验,观察2组检查指标及其3组因子对结核性胸腔积液患者检测的灵敏度与特异性分析并评价其效能.结果 结核组与非结核组检测结果表明ADA及IFN-γ这两种种因子的检测含量及其检出阳性率差异有统计学意义(P<0.05),且2组间TB-DNA阳性检出率间差异有统计学意义(P<0.05).表明三种检测方法在对于结核性胸腔积液的诊断具有显著意义.单因子效能比较中,ADA的灵敏度要高于金标准,但特异性ADA检测相较于其他方法则相对较低,差异有统计学意义(P<0.05).TB-DNA灵敏度为41.28%其较之于涂片法的4.56%,差异有统计学意义(P<0.05).但相比与金标准培养法的灵敏度即在本试验中36.9%依然存在优势.IFN-γ指标测试结果为其灵敏度为76.49%、特异度为94.77%,暗示其检测指标具有很好的指导效能.在并联实验中,ADA或IFN-γ组合具有最高的灵敏度,与其他组比较,差异有统计学意义(P<0.05).而组合为TB-DNA或IFN-γ具有最高的特异性,与其他组比较,差异有统计学意义(P<0.05).其中约登指数最高的组合为TB-DNA或IFN-γ,串联结果特异度最高(99.98%).结论 三种检测方法分别单独使用局限性不能作为单独的诊断标准.使用其中2种大大增强对于该疾病的检出灵敏度与特异度.成为临床检测过程中阳性检出率低、活检过程复杂等相关问题的一大解决方案.

Comparison of diagnostic value of interferon release test,adenosine deaminase detection and DNA detection of mycobacterium tuberculosis in diagnosis of tuberculous pleuritis

Objective To investigate the diagnostic value of interferon ( IFN-γ) release test , adenosine deaminase ( ADA) detection and DNA detection of mycobacterium tuberculosis ( TB-DNA) in diagnosis of tuberculous pleuritis .Methods One hundred and twenty -eight patients were divided into tuberculous pleural effusion group and non -tuberculous pleural effusion group.The levels of ADA,TB-DNA,IFN-γ were detected in both groups to evaluate the sensitivity and specificity of the three factors in diagnosis of tuberculous pleuritis .Results There were significant differences in the levels of ADA and IFN-γ as well as positive detection rate of TB-DNA between tuberculous pleural effusion group and non-tuberculous pleural effusion group ( P <0.05).In single factor detection,the sensitivity of ADA was higher than that of gold standard ,however, its specificity was significantly lower than that in the other methods ( P <0.05).The sensitivity of TB-DNA was 41.28%, which was significantly higher than that (4.56%) of smear method ( P <0.05), moreover, which was also superior to that (36.9%) of gold standard.The sensitivity and specificity of IFN-γ detection was 76.49%,94.77%,respectively,which suggested that these detection indexes had better directive significance .In combination detection ,the sensitivity of combination detection of ADA with IFN-γ was the highest ( P <0.05),and the specificity of combination detection of TB-DNA with IFN-γwas the highest ( P <0.05),in which the Youden index of combination detection of TB-DNA with IFN-γ was the highest, moreover , the specificity of paiallel detection was the highest ( 99 .98%) .Conclusion The single detection out of three methods is limited , thus, which can not be regarded as diagnostic criterium alone .However combination detection of two methods together can obviously enhance the sensitivity and specificity of diagnosis , which provides an new way to solve the problems of lower detection rate and complicated detection process .